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Date��94 <br />y <br />Y <br />a:. <br />Appiication Fo� <br />PUBLIC WORK� <br />O <br />Print or Type Only � <br />r <br />d <br />� <br />M <br />Andrew Auatin Co Inc 9004 191 <br />Owner Mai4ing tli <br />same <br />Describe Proposed Wurk <br />Project Address (if known) <br />new <br />Mailing <br />vk; <br />� 3�Z��F <br />PERMIT <br />TO POSTING ��Z�'�� <br />�oo�8u�ig �oS <br />`O+-� OO.t�O � O N <br />r o"u .. u. ni r in m <br />�.�.nw u �n.o� <br />ir� N <br />� P1 SW Edmon� 9802$ 771-39i <br />x �Y . � ., Zip <br />o�m�ou°�S���r�N� <br />�n"5'�wro-5'm� �iS� � <br />iS ��Y Zip <br />v <br />Attach four (4) copies of plens tor proposed work • Draw to scale and note iha folloviing as applica6le: <br />• ProUerty Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />�� <br />PuEht Worka permil • � � �� � <br />eiao.oeni.._ 4�37t <br />PUEIic Works Fee <br />Totel Fee S <br />Leae AppL Fee PaiE S �_` <br />Belance Due S �!�/ — <br />� 3 <br />• CerteAine of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />DO NOT WRITE BELOW THI <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be mede 24 hrs. in advance - phone 259-8810. <br />2. All work shell be peAormed in accordance with this permit and current City of Everett Desfgn and Construction <br />Standerda end Specificationa <br />3. Call Locatian Underground Service 48 hrs. before yuu d(g. TOLL FREE NUMBER 1•$00�4245555. <br />�• �itG f�Y7tin�c� 5(�il� � GohvG� �'f"•1?G �►'m c'�-GiY� <br />5 ys�.rir Go n neL� o-n �ro v;'c�ed -la �; s La�,�s.e� a-C�c%!'� <br />5, �'ras;�► �-+�vl o�s d,Y,c�,ted [a� pbl�z ►��rks ,1,6�eC�! <br />co. K�p G�� S%Y��T G�PI� �+t � 1/ '�iiHe�. <br />npprovetl as Gonsiructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Evereft, WA 98201 <br />Phone:259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />7he undersigned owner/applicant hereby agrees to hold and save harm- <br />less Ihe City of Everett trom any and all claims lor damages. costs, <br />expenses, or ca s af action that may arise because of instaliation <br />and maintena �of the improvement or other right-oi•way use herelo <br />app!� or u her agree r ove same upon no' e from ihe <br />� ang to lac ublic pr damaged thereby. �� <br />WQRK AUTHORIZED�Y TIiIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF OATF PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY FURSUED TO COMPLETiON. THIS PERMIT MAY 8E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />